Method of treating prostatic hypertrophy

ABSTRACT

Orally administered compositions for treating prostatic hypertrophy are described herein, these compositions contain an effective dose of mediocidin, a polyenic macrolide nucleus. Also the method of treating prostatic hypertrophy with such compositions, is described herein.

iJnite States Patent 1 Gordon Jan. 30, 1973 [54] METHOD OF TREATING PROSTATIC HYPERTROPHY [63] Continuation-in-part of Ser. No. 544,712, April 25, I966, abandoned, and a continuation of Ser. No. 623,847, March 17, 1967, Pat. No. 3,584,118.

[52] US. Cl. ..424/1l5 [51] Int. Cl. ..A6lk 21/00 [58] Field of Search ..424/1 15 [56] References Cited OTHER PUBLlCATlONS Chemical Abstracts 52: P l4l00i (1958) Chemical Abstracts 53: l0526e (1959) Primary Examiner-Jerome D. Goldberg Attorney-Darby 81. Darby ABSTRACT Orally administered compositions for treating prostatic hypertrophy are described herein, these compositions contain an effective dose of mediocidin, a polyenic macrolide nucleus. Also the method of treating prostatic hypertrophy with such compositions, is described herein.

3 Claims, No Drawings METHOD OF TREATING PROSTATIC HYPERTROPHY This application is a continuation-in-part of copending application Ser. No. 544,712 filed Apr. 25, 1966 now abandoned and continuation of application Ser. No. 623,847, filed Mar. 17, 1967, now U.S. Pat. No. 3,584,118.

This invention relates to a composition containing a polyenic macrolide compound and the method of treating prostatic hypertrophy by orally administering the same.

It is known that prostatic hypertrophy may in limited cases be treated by the administration of hormones such as steroids. However, the treatment with steroids or other hormones is severely restricted since its effect is related to the suppression of the secretion of a gonadotropic substance by the adrenal cortex. Further, the administration of a hormone carries with it extensive physiological effects on the organ and organ systems in addition to the prostate. Therefore, there has not been available a composition for the treatment of prostatic hypertrophy which has a broad spectrum of effectiveness independent of the cause of the prostatic hypertrophy.

A great number of polyenic macrolide antibiotic compounds are known today which are used or proposed for use as antifungal chemotherapeutic agents and which have been the subject of extensive scientific investigation in past years. Biologically, the polyene macrolide antibiotics have been recognized to be potent chemotherapeutic agents against a wide variety of yeasts and fungi. However, the use of these polyenic macrolide compounds for the treatment of certain fungal infections has been limited by their poor oral absorption from the gastrointestinal tract. The application of these polyenic macrolide antibiotic compounds has been restricted primarily to topical use.

It has now been unexpectedly discovered that the oral administration of a mediocidin, a polyenic macrolide composition, has a selective effect on the prostate gland in mammals which does not appear to express its effect by stimulating or suppressing hormonal producing endocrine glands. lts effect on the prostate is carried out by reducing its size and altering its hypertrophic histological picture and texture to that of a normal appearing gland. This effect is believed not due to the antibiotic function of these polyenic macrolide compounds but apparently to their chemical structure.

Accordingly, one aspect of the present invention is to provide a method for the treatment of prostatic hypertrophy which comprises orally administering. an effective dose of mediocidin, a specific known polyenic macrolide compound.

Another aspect of the present invention is to provide an orally administered composition for the treatment of prostatic hypertrophy which composition comprises a pharmaceutical formulation comprising an effective dose of mediocidin, a specific known polyenic macrolide compound.

An additional aspect of the present invention is to According to the present invention, the compositions found effective for the treatment of prostate hypertrophy in mammals comprise mediocidin, a polyenic macrolide composition. Since the polyenic compounds were first discovered in l950, a large body of literature has become available describing the extensive chemical investigation of these compounds and demonstrating that they possess generally similar chemical properties. The present broad classification of the polyenic macrolide compounds is due to the work of Oroshnik et al., in 1955 (see Polyene Antibiotics, Science, Vol. 121, pp. 147-l49). ln 1955 only nine polyenic macrolide compounds had been isolated in reasonably pure form but since then well over 50 polyenic macrolide compounds have been reported. Undoubtedly some of these polyenes'have been reported more than once under different names.

The known polyenic macrolide compounds have been produced as antibiotics by cultivation of Streptomyces in different media and by extraction of the substances from these cultures. It has been demonstrated in the literature that the known polyenic compounds are (l) of fairly high molecular weight (ca.700-l500), (2) contain macrocylic lactones, better known as macrolides (hereinafter referred to as polyenic macrolide compounds), and (3) each possess a chromophore in the nucleus of from four to seven conjugated double bonds (tetraenes, pentaenes, hexaenes, andheptaenes) identified by examination of their ultraviolet absorption spectra. These conjugated systems are generally unsubstituted (except the methyl pentaenes) and either of the all-trans or cis-trans configuration. Based on the evidence available to date, it is indicated that the known polyenic macrolide compounds contain a 26 to a 37'membered lactone ring wherein 'all of the ring atoms except the single oxygen atom are carbons. The evidence to date also indicates that only C, H, O, and N are present in the known polyenic macrolide compounds.

The following articles should be consulted for references to the discovery, isolation and chemical properties of the polyenic macrolide compounds:

1. Vining, The Polyene Antifungal Antibiotics" Hindustan'Antibiotics Bull., Vol. 3, pp 32-54 (1960).

2. Waksman et al, The Actinomycetes, Vol. III, Antibiotics of Actinomycetes (Williams and Wilkins, Baltimore, 1962). A

' 3. Droughet, Noveaux' Antibiotiques Antifongiques" Symp. Int. Chirniotherapie, Naples, 1961, pp 21-50(1963).

4. W. Oroshnik 'et al, Fortschritte der Chemie Organischer Naturstoffe" Vol. XXI, pp 18-79 (1963). Among the four distinct classes of polyenic macrolide compounds, that is, tetraenes, pentaenes, hexaenes and heptaenes, the hexaene group of polyenic macrolides is relatively small in comparison to the other groups. To datethe hexaene macrolide compounds have not been structurally elucidated with respect to their substituents to the same extent as the other polyenic macrolide compounds. The spectral data for the few materials reported in this class indicate that they all contain 01,0: -disubstituted all-trans hexaene chromophore. There is also evidence which preliminarily indicates that moieties such as carboxyls, carbonyls, methyls and amines may be present.

Representative of this group are mediocidin, endomycin B (synonymous with helixin B) cryptocidin and flavacid.

It will be understood that where a polyenic macrolide compound of the class herein described is identical with one of the above named compounds, but has been known by another name by reason of independent production or production in accompaniment to other antibiotics, the identification of such substances by the name set forth above is intended to mean the same compound under all other designations.

In the preparation and administration of dosages, a variety of pharmaceutical formulations may be employed, such as capsules, or tablets, preferably in enteric form. The quantity of effective dose supplied by each capsule or tablet is relatively unimportant since the total dosage can be reached by administration of either one or a plurality of capsules or tablets or both. The capsules employed may compose any well known pharmaceutically acceptable material, such as gelatin, cellulose derivatives, etc. The tablets may be formulated in accordance with conventional procedure employing solid carriers, lubricants, etc., well known in the art. Examples of solid carriers are: starch, sugar, bentonite and other commonly used carriers.

The following examples illustrate suitable pharmaceutical formulations containing the compounds of this invention.

EXAMPLE 1 Hard gelatin capsule available from the Robin Pharmacal' Corporation (size is filled with about 0.83

grams of lactose (Fast Flow available from Foremost Dairies, Inc.) and about 100 mg. of active material, the lactose and active ingredient being triturated together in a pestle and mortar until a very fine yellow amorphous powder resulted, prior to filling of the capsule. Obviously, any desired number of capsules may be filled by mixing together any amount of lactose and active ingredient in the same weight ratio indicated above so that each capsule will contain 100 mg. active ingredient; and the quantity of active ingredient may be altered, as desired, by varying the weight ratio of the indicated materials.

7 EXAMPLE 2 125 g. of corn starch and 21 12.5 g. lactose are dried at 140 F. for 12 hours before compounding. After drying, each of these materials is sifted through a No. l4 mesh stainless steel screen. The sifted corn starch and lactose are thoroughly mixed for 30 minutes and to this mixture there is added a blended mixture of 250 g. active ingredient and 12.5 g. magnesium stearate. This admixture is blended and then compressed on a tableting machine into 5000 substantially round tablets each containing 50 mg. active ingredient and weighing about 500 mg.

EXAMPLE 3 'Enteric tablets for use in this invention may be formulated as follows:

16 g. of powdered corn starch (U.S.P. quality) is dried at 120 F. for 12 hours and passed through a No. 25 mesh stainless steel screen. The sifted corn starch is then mixed with 255 g. of anhydrous lactose (direct tablet grade). To this mixture, 4 g. of magnesium stearate is added followed by 50 g. of the active inv gredient. These materials are then mixed in a small pebble mill for 30 minutes and compressed on a single punch machine producing l,000 tablets, each containing 50 mg. active ingredient. Each tablet weighs approximately 325 mg. The average hardness is 6, as measured on a Monsanto Hardness Tester.

The tablets are then placed in a coating pan rotating at 29 r.p.m. and subjected to warm air of approximately F. for about 10 minutes. Then 30 ccs of a pharmaceutical glazed composition is applied, this composition being refined wax and rosin free orange flake shellac with anhydrous alcohol as the medium therefor. Talcum (U.S.P.) or similar dusting powder is applied to the tablets to prevent the tablets from sticking to each other or to the pan and this procedure is followed after the application of each coat to the tablets. The coat is allowed to dry for approximately 1 hour. Thereafter three additional coats are applied in a similar manner, each coat comprising 30 ccs of the pharmaceutical glaze, with approximately 1 hour of drying time between the application of successive coats. After four coats are applied the tablets are dried overnight at room temperature and then four more coats are applied in the same manner using the same composition. Each coat is allowed to air dry for 3 hours before applying the next coat. Each of the 8 coats of the enteric tablets is approximately 0.001 inch in thickness. Obviously, the thickness of the coating can be controlled by varying the concentration of the pharmaceutical glaze in the alcohol medium.

The enteric tablets are tested in accordance with the in vitro disintegration test for enteric-coated tablets described in U.S.P. XVII and were found to pass this test.

While the number of coats used in the example heretofore described is 8, itwill be appreciated that there are many factors to be considered which permit variation in the number of coats, including the size and shape of the tablets or capsules, the type of coat or combination of coats, etc. b

Other procedures and materials well known in the prior art may be employed to prepare suitable enteric coatings. The selection of the coating substance is governed to a large extent by pH and enzyme considerations and the desire to have the enteric composition disintegrate or dissolve when it reaches the duodenum region of the intestinal tract and not in the stomach. The disintegration or dissolution of an enteric coating in the intestinal tract usually depends on several factors, the most important of which are (l) the presence of acidic groups in the enteric substance which. cause it to. be insoluble in the low pH environment of the stomach but soluble in the intestinal tract due to the higher (but usually not alkali) pH of the media there, and (2) the resistance of the coating to attack by oral and gastric enzymes.

Illustrative of other well known substances that may be used for the enteric coating are the following: cellulose acetate phthalate with resinous carrier; cellulose acetate phthalate-tolu balsam-shellac; cellulose acetate phthalate with fats and waxes; shellac-Castor oil; ammoniated shellac; shellac-stearic acid-tolu balsam;

stearic acid-caster oil over shellac-silica gel, cellulose acetate phthalates with or without plasticizer and dusting powder(s); acid phthalates of glucose, fructose, etc; ternary co-polymers of styrene, methacrylic acid and ventral and was palpated to determine its consistency. Visual observation of the bladder, intestines, the caudal I pole of the kidney, and spleen were made, and the palpation of the liver and kidney was accomplished. in all butyl half-ester of maleic acid; alkyd resin-unsaturated 5 but three of the dogs a punch biopsy of the prostate was fatty acids-shel ac; po yvinyl acid pht a e e taken. The biopsy specimen taken from the left hemi- For a description of the procedure for manufacturing spher of the prostate gland was fixed in formalin for enteric formulations such as those exemplified heretohi t l i l d micfgscopig examination Th i fore, reference should be made to US sion ofa biopsy in three dogs was instituted as a control 2,433,244; to determine whether the trauma of taking the biopsy 3,080,345 -f British PM. S- 760,403 of the prostate gland might have some influence on inand ,495. flammation and size of prostatic tissue. In addition, The effectiveness of the compounds of this invention bl d d urine im ns were taken for candicidin in treating prostatic hypertrophy has been confirmed assay d ro ti i ati n, y tests in large m those g g at least The dogs were permitted to recover from the surgical about i kilogram. For example, tests were conducted la ar tomy following which each of the dogs was on dogs to demonstrate the effectiveness of the placed on a regimen of oral administration of canpolyenic macroli compounds in reducing the siz f dicidin in accordance with the schedule of dose adthe Prostate gland- 20 ministration given in Table 1 below. The drug was ad-' in one study, dogs were used to determine the acministered in a hard gelatin capsule in the animal feed.

TABLE I Percent Prostate Size"* decrease Animal in gland Daily body Cranialsize from Dog Age dosage Dose weight Lateral caudal Dorsalin al No. Procedure (years) (mg.) (days) (lbs (mm.) (mm.) ventral volume 1st laparotomy 53 45 35 40 1 ..{2nd laparotomy 10-13 100 so 40 40 a5 40 11.0 Autopsy 00 20 41 42 45 31 7 1st laparotomy. 25 20 20 2 "{2nd laparotomy... 4 100 30 17 17 10 51.5 Autopsy "0 2o 20 17 19 14 24.5 1st laparotomy. 55 26 30 a 2nd laparotom 13 l 100 44 26 a0 22 12.0 "400 14 as 26 25 25 17.0 72 50 50 40 4 "{2nd laparotomy. 10 1' 100 30 61 41 39 82 48. 8 Autopsy "600 14 50 35 27 77 5 {1st laparctomy 17 32 40 30 47.0 Autopsy '2o0 30 2o 34 25 an 6 {istlaparotomy 1o 39 37 30 28 8.5 Autopsy 300 30 25 34 35 25 {1st laparotomy 8 33 37 26 25 21. O Autopsy 300 30 28 27 26, 27 30 no 50455 26.5 as 45-50 40 a0 42 42 34 05.0 it] p t" 3 32 if; 3?; "652 S a T0 om t i 1 at -----{auto?y s00 30 2a 22 24 17 I No biopsy taken.

The daily dosage administered after the first laparotomy. "The daily dosage administered after the second laptlrotom "The prostate volume is approximated by multiplying tion of candicidin, the results of which are reported iii Table I. Each dog was examined for the gross presence of I ,prostatic hypertrophy by palpation. All of the dogs,

y the three dimensions indicated.

A S indicated inTable l a second surgical laparotomy with the exception of two, were at least 10 years of age.

The dogs were housedv under kennel conditions for a week prior to the oral administration of candicidin. During the acclimatization period of the dogs became adjusted to the feeding and kennel routine. A thorough examination of the dogs, including electrocardiography, was undertaken during the acclimatization period. Four of the dogs exhibited a cardiac conditionr;

not unusual for older dogs, which was confirmed byf electrocardiography and subsequently at necropsy.

This cardiac condition did not affect the course of the experimental trial and indeed was helpful in establish-I ing that even in the presence of such a condition can-i dicidin may be safely administered.

After the 1 week acclimatization period, a surgical laparotomy was performed on each of the dogs under general anesthesia. The prostate gland was measured in 7 three dimensions, lateral, cranial-caudal and dorsal-' was performed on four of the 10 dogs in lieu of autopsy because these four dogs were subsequently continued on an altered dose of candicidin to determine whether. increase of the drug dose or discontinuance of dosage! would further affect prostate size. The remaining six dogs were sacrificed and autopsied after completion of the administration of candicidin. The four dogs on which a second laparotomy was performed were autopsied after completion of the administration of candicidin for the period specified in the above table.

fixed and prepared for microscopic examination. The histologic study of the organs listed did not reveal any evidence of drug toxicity.

At necropsy, blood and urine samples were obtained for assay. The assay method was essentially the procedure described for the ssss a'rmsrsnn-csn: dicidin in Assay Methods of Antibiotics 1955, a laboratory method, Donald C. Grove'and William D.

Randall, pp. 116-1 19:.Method 2. The samples of dog serum and urine investigated microbiologically showed no antifungal activity. The assay tests establish the absence of candicidin in'the blood and urine of the test animals.

As shown in the above table, the trauma induced by taking of a biopsy of the prostate gland was not the cause of the reduction in the size of the prostatic tissue. The gross appearance and measurements of the prostatic gland taken prior to the administration of candicidin and at laparotomies performed after the drug had been administered revealed a marked reduction of the size of the prostate gland and normal consistency of the gland which is consistent with a significantly younger age of dog. Microscopic examination of the biopsy specimens of the prostate gland on each dog. taken at each of the surgical procedures performed confirmed the gross observation of normal appearance and a substantial reduction of size. I

The histologic evaluationof the prostate biopsies of dogs taken prior to candicidin administration and at laparotomies did not reveal any cytotoxicity in the gland. The enlarged prostate gland prior to drug administration is characterized by considerable epithelial tufting or papillation; cells are tall, columnar with granular cytoplasm, and gland acini are compressed. The marked reduction in the size of the prostate gland after candicidin administration is accompanied by a decrease in the size of the columnar epithelial cells which are mostly cuboidal; diminished orabsent granularity; and papillations are reduced or absent.

As indicated in the above table, body weight loss does not appear to be related in any quantitive way to the dose of the drug administered since the dogs that received 100 mg/day showed a body weight loss no less or greater than those animals receiving a higher dosage. The data also show that a short time of administration, as noted with dog No. 8 of a relative high dose, 300 mg 4 daily, for 5 days, effected a significant reduction in size of the prostate gland. in the case of dog No. 2, candicidin administration was discontinued after the second laparotomy asindicated in the tableand after an additional days of absenceofdrug administration, it was found that the prostate gland began to increase in size and had achieved about a 50 percent return towards the volume noted at the start of the experiment. However, in this dog the prostate gland was not initially pathologically enlarged.

In some of the dogs diarrhea and vomiting occurred upon the oral administration of candicidin but these effects appeared to be overcome when the dogs were fed a supplement of vitamin B-complex and lacto-bacilli.

Similar tests were conducted on dogs using nystatin (a tetraene). The gross appearance and measurements of the prostate gland takenprior to the administration of nystatin and at laparotomies performed after the drug had been administered also revealed a reduction he chromo hore in the macrolide nucleus the more efective 15 t e compound in treating prostatic hypertrophy. Accordingly, the heptaene macrolide com- ,pounds are preferably used because they have been found to generally give the best results whereas the tetraene macrolide compounds, generally, are least effective in reducing the size of the prostate gland.

It is also indicated that cleavage or other alteration of the macrolide nucleus which opens the lactone ring will destroy the activity of the compounds as-will alteration of the chromophore present in the nucleus by total hydrogenation.

Tests conducted with various polyene macrolide compounds including filipin, amphotericin B and fungifound in the polyenic macrolide compounds are not es- 5 sential to activity for treating prostate hypertrophy.

It is preferred, commensurate with thedesideratum of obtaining the highest degree of effectiveness of the compositions of this invention per given dose of active ingredient, to use an enteric tablet or capsule. Thus when using a specific known polyene macrolide compound in the form of an enteric solid, the entire compound will remain intact when it reaches the intestinal tract so long as the enteric coating composition retains its integrity in the stomach. On the other hand, administration of the same dose in a standard solid pharmaceutical formulation may result in a cleavage of any amino sugar present, or of other groups'similarly sensitive to gastricconditions. Such cleavage may further result in alteration of the polyenic macrolide nucleus,

-thereby diminishing the effectiveness of the active in large mammal in need of such treatment which com- A prises orally administering to said mammal an effective dose for treating prostatic hypertrophy of mediocidin.

2. A process according to claim I, wherein 'said mediocidin is administered in enteric coated form.-

3. A process according to claim 2, wherein said effective dose comprises from about 5 milligrams to about 40' milligrams per kilogram of body weight per day.

s s s 

1. A process for treating prostatic hypertrophy in a large mammal in need of such treatment which comprises orally administering to said mammal an effective dose for treating prostatic hypertrophy of mediocidin.
 2. A process according to claim 1, wherein said mediocidin is administered in enteric coated form. 